This is a multi agency project that brings partners together to form a virtual team to support individuals with acute mental health needs who come into contact with the criminal justice system. Telford and Wrekin Twilight project incorporating Police Liaison (CRHT), local police (West mercia) and Branches ( third sector safe place).
Highly Commended in MH & Emergency Services category - #MHAwards18
From start: No
During process: Yes
In evaluation: No
PP Collaborative: Yes
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Maryan Davies - Operational Manager Crisis Resolution and Home Treatment team, Telford & Wrekin
Telford and Wrekin Twilight project incorporating Police Liaison (CRHT), local police (West mercia) and Branches ( third sector safe place)
Purpose and Aims
To provide early intervention support and appropriate signposting to services for people with diverse mental health needs, who have required police intervention.
Project objectives are:
1. To provide the police with an alternative “ safe place” (Branches) out of hours for adults in a mental health crisis
2. Todevelop effective partnership workingwith the Police, Branches and Crisis Resolution and Home Treatment Team (CRHT)
3.Support the Police in the reduction of Section 136 detentions
4. Reduce A&E attends for mental health problems
5. Reduce police time with people with mental health problems
6. Contribute to the reduction of suicides
7. To increase skills of police to deal with people with mental health problems
8.To assess the impact of the Police Liaison project on care quality and service user experience
9 To explore how the project addresses issues of equality and diversity at the point of access across for service users
The service provides mental health expertise to the police 4 evenings per week with an alternative safe place run by the third sector.
What makes your service stand out from others? Please provide an example of this.
This is a multi agency project that brings partners together to forma virtual team to support individuals with acute mental health needs who come into contact with the criminal justice system
It composes of three main components:-
1The Police Liaison Team is an effective means of improving care quality and service user experience along with, and as an alternative to criminal justice processes. This way of working is effective because it delivers specialist mental health assessment at the point of a crisis, appropriately diverts people away from A&E’s, provides a less restrictive option to formal detention under the MHA 2007, so tackles stigma and frees up police time and provided members of the public with suitable first contact care needs.To ensure the team is embedded in the police workload 1 day a week is spent at the main local police station with 4 evenings a week out in a police care
An example of positive partnership working was when the CRHT twilight police response worker attended to a level one police call with the allocated police officer out of hours to a gentleman on the roadside in a public domain. He was reported to be highly intoxicated, verbalising suicidal ideation and struggling with PTSD – the gentleman is a veteran experiencing traumatising memories of a tour of duty and dealing with recent news of an ex-soldier he served with having recently completed suicide.
On arrival the gentleman was distressed and initially difficult to engage. Having the availability of an alternative “safe place” the attending police officer and the CRHT worker were able to triage and determine the level of mental health support required. This led to the provision of least restrictive interventions that were discussed with and ultimately provided by Branches night service support workers. The police officers concerned stated that had they not have had the immediate availability of the mental health practitioner and the Branches night support staff, they would have felt obliged to deploy their police powers of a Section 136 of the Mental Health Act (2007). The intervention and support provided by the Branches night service enabled the gentleman to receive emotional support within a safe environment at an appropriate time and access statutory mental health service support follow up from the CRHT service.2 Police car working with liaison team 4 twilight shifts per week- 6pm to 1 am. The police have provided a main liaison care on the evenings that the service is in operation. The car attends all mental health calls and the service is able to assess the individuals and then offer a safe place that offers support and can defuse the situation
3 Branches- this is a third sector safe place where staff have mental health experience. It is staffed from 6pm to 2am and is part of their mental health offer in Telford and Wrekin. Branches offer support, advice and a listening service 6 days a week. Part of the role of the twilightservice is to calm the situation but then offer the support of the main service in courses, listening, and problem solving.
How do you ensure an effective, safe, compassionate and sustainable workforce?
Police liaison service:- Senior Community Mental Health nurses working within an established urban based CRHT provide the Police liaison team support. They are competent skilled and experienced Mental health Nurses who are able to assess, plan and implement urgent care pathway plans of care.
The rota consists of a dedicated twilight worker for each Thursday, Friday, Saturday and Sunday. Funding to support this initiative was provided by the CCG enabling an uplift of band 5 nurses to band 6 who had expressed an interest in developing multi-agency partnerships. The identified workers were recognised as people with a passion for working with diverse minority groups who are regularly brought to the attention of the police and other emergency services including A&E and the ambulance services.
Prior to the launch of the police liaison project a rota was developed with the e-rostering manager to design a shift pattern that mirrored the hours of Branches night service. This was to ensure that the Branches night service workers and the police had easy ready access to a mental health practitioner for advice and support. A rota pattern was developed that would meet the needs of the police liaison team but also provide a good work life balance for the CRHT staff concerned.). The CRHT police response worker is allocated a dedicated police officer for each shift who will meet them at an agreed location and the CRHT worker of than officers for all attendances to calls
Police service:- 1 officer per evening.This changes which ensures all police officers have the opportunity to increase their knowledge and skills of mental health. Training on mental health awareness was undertaken before the project began
Branches2 support workers work 0.85 WTE over 4 twilight shifts Thursday through to Sunday
Who is in your team?
Siobhan Beck Manager Branches
Branches night service
CRHT Police Co-ordinator WTE
Hannah Corfield CRHT Police Co-ordinator WTE
Maryan Davies CRHT Operational Team Manager /Police Liaison Project Lead WTE
Inspector Gary Wade
West Mercia Police Safer Neighbours Team North Inspector / Police liaison project lead
Inspector Mark Reilly
West Mercia Police Inspector / Mental Health Lead
How do you work with the wider system?
CRHT have two dedicated Police Liaison Co-ordinators who work collaboratively with both the police service and Branches night service support workers. There is a bi-monthly police liaison project focus group attended by all parties concerned.
We have referral pathways into both the voluntary sector and statutory services which the CRHT twilight worker will access with support from the CRHT service.We also work closelywith other teams includingthe Access team, who provide a 24hour access to mental health services andRapid Assessment Interface andDischarge (RAID) team based at the County General Hospital Princess Royal Hospital Telford.
Below is an example of true partnership working with very positive feedback from Police Colleagues
I was recently advised of your colleague, Hannah Corfield’s assistance at the scene of an incident whilst off duty.
At 20:40 hours on Tuesday 20th March, Hannah was off duty, when she came across the scene of a Police incident.
An adult male had climbed upon a railway bridge, above a road, and was threatening to jump off.
In total the incident attracted the services of 15 Officers and Staff, as well as a passing Fire and rescue crew who had stopped to re-direct traffic.
Hannah immediately went in to support the male and negotiated with him for over half an hour, before accompanying him off the bridge and handing him to other colleagues, safe and well.
I consider this to be a stunningly brilliant example of partnership working and wanted to bring it to your attention, so that you could convey our thanks and appreciation to Hannah, for her efforts.
Very best regards
Chief Inspector XXX
Branches twilight service connects to the main Branches offer which has a focus on supportingrecovery and also has close connections with substance misuse support, The model is supported by volunteering and supporting chances for future employment. The day time service has 30 plus volunteers. The twilight service is staffed by local individuals who understand the local mental health issues
Case studies “A lady was reported to the police for concerns as she was suicidal on a bridge, she agreed to go to Branches night service. She had a relationship breakdown and was in debt for 10k and was under the influence of alcohol. We referred her for financial support and advice and listened to the issues she has.
The lady was not put on a 136 as her mood was de-escalated and she felt better for talking”.
“A 16 year old male was reported to police for safety claims after climbing over bridge at the railway station, he was taken to Branches night service. He had fallen out with his girlfriend which had made him feel suicidal and he already had depression, this breakup had impacted on his social group and left him feeling isolated. He has not seen CAHMs for over a year and missed his last appointment. He did have a therapist and a call was made to EDT to inform them.Strategies on how to deal with these feelings were discussed and a plan made for him to contact police in future if he felt unsafe. He was de-escalated and taken home to his parents”
Do you use co-production approaches?
Liaison workers- Given the nature of referrals coming via the police it is very difficult at that initial point of contact to gain service user/carer views in terms of service development. However future objectives are to collect and analyse data pertaining to the service user experience when supported by the police liaison team.
Branches is a local third sector service where experts by experience run the service and support others. They are involved in all developments at Branches and provide feedback for any work
Do you share your work with others?
The CRHT Police Co-ordinators have a designated day to spend with the Police attending briefings and being available to the police teams to give briefings on the role and responsibilities of the CRHT Police Liaison team.
All Focus group meetings are minuted and these are shared with the Police, Mental Health Service managers, Branches night service and service leads, Commissioners for CCG and Local authority. There is also regular attendance at the High Intensity meetingsand the police vulnerability meetings where updates are provided.
An example of wider shared learning regarding the success and challenges of the Police Liaisoninitiative is copied below
Hannah / Shev,
I’ve been passed the information below by our police representative – they are impressed with what you have done and asked if this is something we could look at in Worcestershire.
Are you able to provide any further information about what you do, how the service is structured ie. who funds the posts, operational protocol and is there any evidence you have used to support the model when you were developing it.
If there are any further details you could send that would be helpful, or alternatively if you able to offer some time to have a discussion over the phone I’d be really grateful to arrange a time to talk.
Practice Educator / Approved Mental Health Professional Lead
Worcestershire Health and Care NHS Trust
Telford has a Mental health forum across the borough which has over 30 organisations taking part.It provides an opportunity for voluntary and public organisations to work information and work. Itensures positive relationships between organisations and ensures there is always an organisation around who can support whatever the individuals issues are – ie housing, benefits, employment, LGBT issues,family relationships.
Branches is jointly composed by the council and the CCG so both organisations are updated on their work
Updates on the progress of Branches are shared at the Telford health and wellbeing Board.
What outcome measures are collected, how do you use them and how do they demonstrate improvement?
Collaborative working with our inpatient colleagues who staff our local 136 suite, (located at the Redwoods centre in Shrewsbury) send monthly reports to the Police Liaison lead. This enable the focus group to consider resource allocation at peak times that Section 136 is being executed.
The Police Co-ordinators have initiated a suggestion box within the CRHT team base to enable CRHT staff members to comment on any aspects of the twilight worker role and likewise a suggestion box that is emptied each week is located at Malinsgate Police Station to enable all Police officers to comment and share their views on the partnership patrols and use of the alternative “safe Place located at Wellington Police station”
Positive feedback from our local Authority colleagues below indicating a reduced number ofout of hours MHA assessments over last month.
I just wanted to report to you our EDT MHA data this month, we have had 7 MHAAs for May, it has never been so low!! Usually averages around 20 a month so this is brilliant progress, I think the police responder role has been key ensuring police are well informed and carefully consider use of 136,
Well done all!!
Team Manager / AMHP
Emergency Duty Team,
All CRHT twilight worker contacts are logged on RIO (Electronic Health system) using a Community triage form indicating level of intervention and outcome including avoidance or recommendation for detention under Section 136.
A request has been placed with the RIO Clinical Systems team to draw down a report which will indicate peak periods of activity and enable us to tailor the shift pattern ensuring the police response worker is available at times of high demand.
Branches collects data manually and feeds back with case studies.
“Made me understand that life is actually beautiful and my fears no longer have power over me. I’m in control.”
“Helped me understand my feelings which were hidden/buried. Assured me that I am doing the right things and that it is okay to feel what I have felt.”
“I feel a lot more excited about my future and life in general. I would recommend the service to any one suffering with mental health.”
“It has made me feel like I am worthy again.”
Has your service been evaluated (by peer or academic review)?
How will you ensure that your service continues to deliver good mental health care?
Ensuring outcomes are recorded and reported to commissioners
Collating feedback and presenting to organisations involved- PCC, Health and Wellbeing Board, CCG
Third sector supported to find alternative funds ( ie lottery etc, local companies)
What aspects of your service would you share with people who want to learn from you?
Taking a whole system approach and ensuring organisations work together to benefit them all! Often we change things in the public sector but it can have negative impact on other organisations- this has been a whole system approach
It needs dynamic frontline staff who want to make things work for the benefit of patients.Just an idea won’t get anywhere unless the frontline staff work together, deal with any issues themselves and make it work.
There will be problems/ issues but they can be sorted by people being open accepting challenging and not being precious.
How do people access the service?
Via the police
How long do people wait to start receiving care?
How do you ensure you provide timely access?
Nurse is in a police car
What is your service doing to identify mental health inequalities that exist in your local area?
Issues feedback directly to commissioner- close relationship
What inequalities have you identified regarding access to, and receipt and experience of, mental health care?
Homelessness- this was the start of another project for Branches working with the homeless in evening with Telford and ensuring they are safe and trying to bring them into ‘treatment/support ‘services.
What is your service doing to address and advance equality?
Raising awareness with police around mental health issues. Working to raise awareness of mental health issues across the borough- Branches in the park concert/event when mental health first aid training provided